For a woman with type 1 diabetes, the confirmation of pregnancy at her 10-week ultrasound is filled with far more than joy and excitement. Every appointment she attends thereafter will likely include a repetitive reminder of just how crucial tight blood sugar management will be to reduce the risks of a variety of complications for both her and her growing baby in utero.
One of those risks is autism.
“The three main types of diabetes -- type 1, type 2, and gestational, which develops during pregnancy -- increase a woman’s risk of having a child with an autism spectrum disorder (ASD),” explains a 2018 study published in the Journal of the American Medical Association (JAMA).
The increased risk and incidence of autism in children born to mothers with type 2 diabetes and gestational diabetes had been established in earlier studies, but this study involving nearly 420,000 children born between 1995 and 2010 pinpoints a link with type 1 diabetic mothers, too.
In fact, the incidence may actually be higher in mothers with type 1 diabetes than with type 2 or gestational.
Of the 420,000 children in the study, 5827 children were diagnosed with autism before turning 7 years old.
But the existence of the mother’s diabetes alone is not what necessarily increases the risk. Instead, the mother’s overall health and management of her diabetes is the crucial factor.
“Researchers really don’t know the reason diabetes may be contributing to a child developing autism,” explains Jennifer Smith, RD, CDE and well-known pregnancy coach for women with diabetes at Integrated Diabetes working with clients across the globe via Skype.
Smith adds, however, that the risk seems to be highest in those with higher HbA1c levels, even prior to becoming pregnant, and the mother’s overall blood sugar management during pregnancy.
“The A1C test measures what percentage of your hemoglobin—a protein in red blood cells that carries oxygen—is coated with sugar (glycated),” explains Jennifer Smith in our book, Pregnancy with Type 1 Diabetes.
Your A1C tells the approximate range of your blood sugar control for the prior 3 months based on the amount of Advanced Glycation End-Products (AGEs) that have accumulated in your blood.
“AGEs are, in a nutshell, the result of excess glucose in your bloodstream. The higher your blood sugar levels are, the more AGEs are present.”
AGEs are also responsible for the development of long-term diabetes complications such as retinopathy and neuropathy, because that accumulation will build and irritate crucial nerve-endings.
When you add a growing fetus to the mix, while the fetus’ body manages its own blood sugars, it’s still seemingly impacted by the mother’s overall blood sugars, and of course, overall wellbeing.
But this doesn’t mean that women with type 1 diabetes should sit in fear or even avoid pregnancy just because of this increased risk. A great deal of this risk can be reduced with aggressive, educated and intense blood sugar management prior to and during pregnancy.
“To avoid the potential development of issues during pregnancy, it is imperative to have your blood sugars in the healthiest control possible prior to conception,” explains Smith, “as well as in that first trimester during which all of the fetal systems, including the brain, are forming.”
Like the many other risks and possible defects women with type 1 diabetes are warned about at every ultrasound and appointment, autism is just one of those possible outcomes. Many, many women with type 1 diabetes give birth to remarkably healthy babies.
“If a birth defect (in any baby with a diabetic mom or not) is going to occur, it will happen during the first 8 to 10 weeks of the embryo’s life when the ‘body systems’ are forming,” explains Smith's book. “Those body systems include: digestive systems, endocrine system, respiratory system, reproductive system, circulatory system, skeletal system, lymphatic system, muscular system, urinary system, nervous system.”
Once those systems are developed, the fetus is growing and essentially “learning” for 9 months in utero how to use all the body systems that have been established. Some systems include organs that mature over time, such as the lungs, but once they are formed in those first 8 to 10 weeks, the birth defects already exist.
Once again, this means that blood sugar management during the months prior to conception and during that first trimester is vitally important for preventing the development of birth defects.
While not all pregnancies are or can be planned, if you are a woman with type 1 diabetes who knows she would like to someday pursue pregnancy, give yourself time before you begin trying to conceive, to focus on your overall blood sugar management. Include every part of your healthcare team and get all the support you need (including, for many, a continuous glucose monitor) to make this daunting yet worthwhile challenge as smooth as possible. It won’t be easy, but it will be worth it.
“Diabetes management during pregnancy,” adds Smith, “is a labor of love!”